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NEWPORT INTERNATIONAL JOURNAL OF

RESEARCH IN MEDICAL SCIENCES (NIJRMS)

Volume 5 Issue 1 2024

Page | 118
https://doi.org/10.59298/NIJRMS/2024/118.12757.1400

Factors Influencing Utilization of Cervical

Cancer Screening Services among Women 20
Years or More Attending KIU-Teaching
Hospital in Ishaka Bushenyi
Musubika Judith

Faculty of Clinical Medicine and Dentistry Kampala International University Western Campus Uganda

ABSTRACT
Worldwide, cervical cancer strikes almost half a million women every year and is fatal in approximately half of these
cases, particularly those in developing countries where screening programs are not well established with over
493,000 new cases of cervical cancer occurring each year among women, and 274,000 women dying of the disease
annually. This study was designed to determine factors influencing the utilization of cervical screening services
among women over 20 years attending KIUTH, Ishaka Bushenyi, Western Uganda. A descriptive cross-sectional
study among 70 women 20 years or more attending KIUTH in Bushenyi district was sampled randomly and using
a self-administered questionnaire, data was collected, coded, entered, and analyzed using IBM SPSS version 20;
presented in frequency and percentage charts and tables and P-Values where necessary. According to the study
findings, 70% had ever screened for cervical cancer. Using Pap smear (51.4%), VIA (37.1%) and Histology (11.4%).
The majority 56(80.0%) had ever heard about cervical cancer. Mostly 39(55.7%) acquired their information from
Health workers and to a considerable extent 20(28.6%) from media 55(78.6%) for expensiveness as the main
hindrance. 52.4% not screened were not aware of the availability of the services. Nonetheless, 42(85.7%) among the
screened agreed that the services were available but this was not statistically significant. A significant effect was
noted with health workers’ sensitization about STIs 44(89.8%); 33(67.3%) further agreed that services cover cancer
(cervical) prevention offering professional advice 42(85.7%). Once counseled, 33(82.5%) agreed that cervical cancer
could be prevented. The utilization level stands at a good position with up to 70% screening mostly using pap smear.
On an individual level; Health workers and media increases awareness and thus utilization. Statistically, health
facilities/workers could further empower the utilization of cervical cancer screening through sensitization,
counseling, and guidance concerning utilization. However, affordability, safety, and accessibility of such services and
misinformation remain a hindrance to the utilization of cervical cancer screening services.
Keywords: Cervical cancer, Women, Cervical screening, Pap smear.

INTRODUCTION
Worldwide, cervical cancer strikes almost half a million women every year and is fatal in approximately half of these
cases, particularly in developing countries where screening programs are not well established [1]. In Sub-Saharan
Africa, cervical cancer is the second most prevalent type of cancer among women [2]. Reports show that the cervical
cancer survival rate in the sub-Saharan African region was 21% in 2002 in comparison to that of 70% and 66% in
the United States and Western European countries respectively [3]. Cervical cancer is the most common
malignancy of women in Uganda and the majority of the women who report to the hospital are at the advanced stage
of the disease where death is imminent [4, 5]. It is estimated that every year approximately 40 women in every 100,

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000 develop cervical cancer in Uganda compared to the global incidence of 15 per every 100,000 women. Statistics
confirm that about half of the women with cervical cancer die within three years of diagnosis [6]. Projections show
that by 2025, about 6,400 new cervical cancer cases and 4,300 deaths will occur annually [7]. Cancer of the cervix
results from persistent infection with specific strains of human papillomavirus (HPV), a large family of viruses, of
which other strains cause benign warts [8, 9]. Lesions have been associated with the development of cervical cancer
but women with; HPV infection, smokers, weakened immune systems (for example HIV infection), Chlamydia
infection, a diet low in fruits and vegetables, overweight, having multiple term pregnancies, being younger than 17 Page | 119
years at first full-term pregnancy, long use of oral contraceptives, IUDs use, family history of cervical cancer and
being of a low economic status are more at risk of developing the disease [10-12]. Young women are at higher risk
just because they tend to be sexually active and have higher numbers of sexual partners [13]. Research also has it
that young women are poorly informed about cervical cancer and the associated risk factors, are unclear about the
purpose of cervical cancer (CaCx) screening, and hold negative or inaccurate beliefs or attitudes about Pap testing
[13]. On a general note, poor knowledge, lack of awareness, and late diagnosis of various types of cancers preclude
treatment outcomes [14-16]. Poor knowledge about cervical cancer, and lack of awareness of available screening
methods have been identified as the most important factors hindering the use of available cervical cancer screening
services [17]. Levels of utilization of the screening services differ worldwide and this has resulted in an increased
overall prevalence of cervical cancer cases globally. Cervical cancer ranks as the 1st most frequent cancer and the 2nd
among women between 15-44 years with rapidly increasing rates with 4,379 new incidences and 2,511 new
maternal mortalities from the disease [18]. This was comparable to the WHO report which estimated morbidity to
be 3,915 Ugandan women and 2,160 cervical cancer mortality [19]. Furthermore, annually, 40 women per 100,000
develop cervical cancer in Uganda and about ½ of these women die within 3 years of diagnosis [6]. Uganda Cancer
Society showed that the cervical cancer burden was as high as 45 women per 100,000 as compared to the global
incidence of 15 women per 100,000. It added that Uganda has 3 times the global burden of new cases of cervical
cancer and projections show that by 2025, about 6,400 new cervical cancer cases and 4,300 deaths will occur annually
[7]. However, the factors were different in the different regions of the country. In Uganda, an Oyam district study
in the north revealed that of the 62.7% of women attending health services at the various Health center IIIs who
had ever heard about cervical cancer, only 35.1% had ever screened [6]. Similarly, in 2 districts in Eastern Uganda,
out of the 4.8% of women who knew, 37.2% had voluntarily gone for the screening [20]. At Mbarara Regional
Referral Hospital, the proportion of cervical cancer was found to be high (25.2%) contributing to 10.1% of all
gynecological diseases and 73.9% of all gynecological cancers [21]. In Isingiro, western Uganda among rural
women; a 4.62% knowledge about cervical cancer but with only a 0.33% utilization rate of the screening services
[22]. Cervical cancer is the most common malignancy of women in Uganda and over 80% of the women who report
to the hospital are at the advanced stage of the disease where death is imminent [1]. However, there is no data on a
comprehensive assessment of these and other associated factors in the study area. Therefore, this study intended to
determine the factors among women 20 years or more attending KIU-Teaching Hospital (KIU-TH) to guide
healthcare providers and other stakeholders to plan appropriately to deliver informed and evidence-based services
to control and prevent morbidity and mortality from these insidious killer diseases.
METHODOLOGY
Study Design
A descriptive cross-sectional study design with both quantitative and qualitative data was used during April -
August 2019.
Area of Study
The study was conducted at KIU-Teaching Hospital. The hospital is located in the town of Ishaka, Bushenyi district,
Western Uganda, along the Mbarara- Kasese Road. It is approximately 77km (48miles), west of Mbarara town, the
largest town in the sub-region.
Study Population
The study targeted all women 20 years or more attending the ANC and Maternal ward of KIU-TH.
Inclusion Criteria
All women 20 years or more attending the ANC and Maternal and GYN ward of KIU-TH, who have consented,
were included in the study.
Exclusion Criteria
This study excluded critically ill women, emergency cases, and those who declined to consent.
Sample Size Determination
The sample size was determined using the Kirsch and Leslie, [23] formula.

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Where;
S = the sample size
Z = 1.96 at 95% confidence interval.
δ= 5% Margin of error Page | 120
P= 4.8%
Therefore, our sample size is;
S=

Therefore; the sample size was 70 participants.

Sampling Procedure
A simple random sampling technique was employed in data collection. The researcher administered a standard
questionnaire to the participants on their respective wards and whoever was present at that time of data collection
was provided with a questionnaire.
Data collection
Standard questionnaires with open and closed questions were used as instruments for collecting data. These were
administered to eligible participants to collect quantitative and qualitative data.
Research procedure
Women attending KIU-TH at ANC, GYN, and Maternity ward were sensitized and educated about the purpose of
this study and assured of confidentiality of the information they will give. Those who will have accepted and are
eligible, 20 years or more will consent by consent forms which were written in English and translated in Runyankole.
The recruitment then took on immediately for the eligible patients who consented to participate in this study. Socio-
demographic, personal, health facility-related, and intervening factors as previously illustrated in the conceptual
framework were recorded through questionnaires.
Data Management
The questionnaire was pretested on 5 women at the gynecology ward at Kampala International University Teaching
Hospital. Pre-testing will help in verifying any ambiguous question that may not have been addressed. The results
of this pretest were used to modify the content and consistency of the questionnaire.
Data Management
The filled-in questionnaires were checked for validity and completeness before leaving the data collection site. Data
was coded and it was entered correctly in the computer and backups were made for safe storage. The questionnaires
were kept out of research to unauthorized persons.
Data Analysis
Data was analyzed using IBM Statistical Package for the Social Sciences (SPSS) version 20. Data sets were cross-
tabulated using descriptive analysis, and presented in figures, proportions, percentages, correlations, central
tendencies, and dispersions. Simple explanatory notes and conclusions were made following the analyzed data.
Ethical considerations
Approval was sought from the Research Ethics Committee of Kampala International University, Western Campus,
and ethical concerns were addressed. Restricted access to the data collection forms by persons other than the
principal researcher was ensured, because of the personal information which was included. The identity of the
respondents will remain anonymous and confidential throughout the course of data handling. The respondents were
properly informed upon this subject and neither will they be forced or influenced to answer any question as per the
researcher’s interest. Verbal consent by the researcher was obtained from the respondents who were informed about
the importance of the study.

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RESULTS
Table 1: Socio-demographic Characteristics of the study participants
Variables Frequency Percentage
(n=) (%)
Age Page | 121
25 or less 23 32.9
26-35 33 47.1
>35 14 20.0
Religion
Anglican 20 28.6
Catholic 31 44.3
Muslim 17 24.3
Born-Again 2 2.9
Level of Education
Primary 18 25.7
Secondary 34 48.6
Degree 18 25.7
Marital status
Single 12 17.1
Married 48 68.6
Divorced 10 14.3
Occupation
Civil servant 25 35.7
Business 12 17.1
Student 26 37.1
Unemployed 7 10.0
Area of residence
Ishaka Town 16 22.9
Bushenyi Village 27 38.6
Away from Bushenyi District 27 38.6
Number of children
1 or none 28 41.8
2-3 32 47.8
>3 7 10.4
N=Frequency %=Percentage
The level of utilization of cervical cancer screening services among women 20 years or more attending
KIUTH.

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EVER SCREENED FOR CERVICAL CANCER

Yes No

Page | 122

30%

70%

Figure 1: The level of utilization of cervical cancer screening services among women over 20 years attending
KIUTH
According to the study findings, the majority 70% had ever screened for cervical cancer. The majority of these were
reported screened using Pap smear (51.4%), VIA (37.1%), and Histology (11.4%).
SCREENING METHODS USED

Screening Methods Used

60.00%

50.00%
51.40%
40.00%
37.10%
30.00%

20.00%

10.00%
11.40%
0.00%
VIA PAP smear Histology
Figure 1: Methods used During the Cervical cancer Screening Services
The personal factors affecting the utilization of cervical cancer screening services among women 20 years
or more attending KIUTH.
According to the study findings, the majority 56(80.0%) had ever heard about cervical cancer, of whom all
49(100.0%) had been screened already. Mostly 39(55.7%) acquired their information from Health workers and to a

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considerable extent 20(28.6%) from Media (TV/Internet). However, the majority 55(78.6%) and 36(73.5%) of the
total study participants and those ever screened already put forth expensiveness as the main hindrance to cervical
cancer screening. And some 8(11.4%) and 7(10.0%) put forth Fear of adverse outcomes and Inaccessible services as
hindrances. Despite all that, 26(37.1%), 25(35.7%), and 19(27.1%) encouraged Regular screening, avoiding multiple
sexual partners, and Avoiding early sex to play a big role in cervical cancer screening respectively. All this is
normally part of the counseling at the health facility or from health workers concerned with such services which
they claim are mostly expensive. Page | 123
Table 2: The personal factors affecting the utilization of cervical cancer screening services among women
over 20 years attending KIUTH
Variable Ever Screened for cervical cancer TOTAL
[N(%)]
Yes [N(%)] No[N(%)]
Ever heard about cervical cancer
Yes 49(100.0%) 7(33.3%) 56(80.0%)
No 0(0.0%) 14(66.7%) 14(20.0%)
Source of information
Health workers 28(57.1%) 11(52.4%) 39(55.7%)
Lectures 2(4.1%) 2(9.5%) 4(5.7%)
Media (TV/Internet) 13(26.5%) 7(33.3%) 20(28.6%)
Books 6(12.2%) 1(4.8%) 7(10.0%)
Hindrance to Cervical Cancer Screening
Inaccessible services 7(14.3%) 0(0.0%) 7(10.0%)
Fear of adverse outcomes 6(12.2%) 2(9.5%) 8(11.4%)
Expensive 36(73.5%) 19(90.5%) 55(78.6%)
Cervical cancer Preventive measures taken
Avoid early sex 12(24.5%) 7(33.3%) 19(27.1%)
Regular screening 20(40.8%) 6(28.6%) 26(37.1%)
Avoid multiple sexual partners 17(34.7%) 8(38.1%) 25(35.7%)

N=Frequency %=Percentage

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The health facility-related factors influencing women’s utilization of cervical cancer screening services at
KIUTH.

Cervical cancer Screening Services Availability at the

Health facility
60.00% Page | 124
% Screening Services Availability

50.00%

40.00%

30.00%

20.00%

10.00%

0.00%
Yes No I Dont Know
Screened 37.50% 16.70% 45.80%
Not Screened 38.10% 9.50% 52.40%
Figure 2: Cervical cancer Screening Services Availability at the Health facility
According to the study findings, the majority of those not screened (52.4%) were not aware of whether the services
were available or not, 9.5% reported the services being unavailable whereas 38.1% did not screen despite knowing
where the services were. Nonetheless, 42(85.7%) among the screened agreed that the services were available but this
was not statistically significant. A significant effect was noted with health workers’ sensitization about STIs
44(89.8%); P-Value=<0.001, OR=9.68(2.74-34.15); 33(67.3%) further agreed that services cover cancer (cervical)
prevention P-Value=0.001; OR= 6.60(2.05-21.23). Also, offering professional advice had 42(85.7%), P-
Value=<0.001 and OR=9.75(2.97-32.05). and Once counseled, 33(82.5%) agreed that cervical cancer could be
prevented; P-value=0.001, OR=10.37(2.73-39.42). See Table 3.
Table 3: The health facility-related factors influencing women’s utilization of cervical cancer screening
services at KIUTH.
Variable Ever Screened for cervical cancer TOTAL P-Value OR
Yes [N(%)] No[N(%)] N (%) [95% C.I]
Cancer services available at your convent health facility
Yes 42(85.7%) 16(76.2%) 58(82.9%) 0.333 1.88(0.52-6.77)
No 7(14.3%) 5(23.8%) 12(17.1%) Ref 1
The health facility/health workers sensitize about infections (STIs)
Yes 44(89.8%) 10(47.6%) 54(77.1%) <0.001* 9.68(2.74-34.15)
No 5(10.2%) 11(52.4%) 16(22.9%) Ref 1
Services cover Cancer (Cervical) Prevention
Yes 33(67.3%) 5(23.8%) 38(54.3%) 0.001* 6.60(2.05-21.23)
No 16(32.7%) 16(76.2%) 32(45.7%) Ref 1
They offer Counseling and professional advice
Yes 42(85.7%) 8(38.1%) 50(71.4%) <0.001* 9.75(2.97-32.05)
No 7(14.3%) 13(61.9%) 20(28.6%) Ref 1
Can cancer be prevented once counseled
Yes 33(82.5%) 5(31.2%) 38(67.9%) 0.001* 10.37(2.73-39.42)
No 7(17.5%) 11(68.8%) 18(32.1%) Ref 1
*Statistically Significant, P-Value=<0.05OR=Odds Ratios Ref=Reference category

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DISCUSSION
The level of utilization of cervical cancer screening services among women 20 years or more attending
KIUTH.
According to the study findings, the level of cervical cancer screening stands at 70% among women 20 years or older
attending KIUTH. This is far better compared to a report in a study by Mulatu et al. [3] in which it was concluded
that there was a poor utilization of screening services at 14.8%. Also, in another study, 41.9%; thus cervical cancer
screening is very low among University of Botswana female students [24]. The majority of these reported screened Page | 125
using mostly Pap smear, followed by VIA and Histology. This is comparable to another study in which the majority
had heard about the Pap smear and a good number took the test, which is relatively higher than in the study
conducted by Hoque and Hoque [13]. Similarly, a study by Memirie et al. [25], concluded that only a few of the
participants knew visual inspection via acetic acid, and the majority reported having used and aware of Pap smear.
This could be generally a common issue the world over especially in Africa. Early screening for cancer facilitates
chemotherapeutic efficacies and thus reduces cancer-related mortalities [26-28].
The personal factors affecting the utilization of cervical cancer screening services among women 20 years
or more attending KIUTH.
All those that had been screened already acquired their information from the Health workers and to a considerable
extent from Media (TV/Internet). This complements a study in which it was concluded that a lack of knowledge
coupled with misconceptions about susceptibility impacted on college students’ attitudes and behaviors regarding
cervical cancer prevention [29]. However, being aware does not necessarily correspond to a correct understanding
of the disease thus the need of addressing young female attitudes towards cervical cancer [29]. Also, multiple sexual
partners and avoiding early sex play a big role in cervical cancer screening. This adds to a study in which women
felt that the disease is mostly for unmarried women and those with multiple sexual partners, hence the reluctance
[30]. All this is normally part of the counselling at the health facility or from health workers concerned with such
services which they claim are mostly expensive. Despite all that, many encouraged regular screening, avoiding
multiple sexual partners and avoiding early sex to play a big role in cervical cancer screening. This is comparable
to a study done to assess barriers to utilization of cervical cancer screening in Ethiopia which reported that cervical
cancer and the screening were associated with misconceptions such as promiscuity behaviors [31].
The health facility-related factors influencing women’s utilization of cervical cancer screening services at
KIUTH.
According to the study findings, the majority of those not screened (52.4%) were not aware of whether the services
were available or not, 9.5% reported the services being unavailable whereas 38.1% did not screen despite knowing
where the services were. A hospital-based study conducted among women of reproductive age to assess factors
associated with cervical cancer screening revealed a lack of knowledge and awareness about cervical cancer
prevention among the participants [30]. Nonetheless, service availability was not statistically significant. A
significant effect was noted with health workers’ sensitization about STIs which increased odds to 9.68(2.74-34.15)
times to more likelihood to utilize the services. Similarly, services covering cancer (cervical) prevention were
6.60(2.05-21.23) more likely that one would utilize the services. This complements a study in which many feared
that being diagnosed with a disease of the private parts may mean that the woman has cheated on her partner which
may cause conflicts, hence the reluctance [30]. Furthermore, offering professional advice had 9.75(2.97-32.05) odds.
And once counseled on how cervical cancer could be prevented it increased 10.37(2.73-39.42) more times to further
utilize the services. As earlier reported, the fear of being diagnosed with cervical cancer has been reported as a barrier
to cervical cancer screening among Kenyan women, where respondents believed that being diagnosed with a
sexually transmitted disease is associated with promiscuous behaviors [32]. With such knowledge of the hindrances,
focused counseling and guidance could actually aid in the increase of the utilization of the cervical cancer screening.
The use of Religious leaders as champions of cervical cancer screening campaigns can yield an increased acceptance
by women. This is because religious leaders are highly respected by women especially women residing in rural areas.
Previous researchers have observed that the utilization of religious leaders as advocates for health promotion has
proven to be helpful [33, 34].
CONCLUSION
The utilization level stands at a good position with up 70% to screening mostly using pap smear. On an individual
level, Health workers and media increases awareness and thus utilization. Statistically, facilities/workers could
further empower the utilization of cervical cancer screening through sensitization, counseling and guidance
concerning utilization and prevention as well as demystifying misinformation on effects of such services, particularly
the screening process. However, affordability, safety and accessibility of such services remain a hindrance to
utilization of cervical cancer screening services.

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RECOMMENDATION
The stakeholders especially the health workers at the facility should emphasize and advise these women to go for
screening through sensitization about the benefits and likely and/or possible effects of the failure to do so; this will
address the levels of services utilization particularly screening and counseling which probably decrease the
rampantly increasing morbidity as well as mortality associated with cancer in women. Massive free screening
campaigns and vaccination as well as counselling and guidance sessions should further be advocated for to increase
the coverage and lower misinformation surrounding the side effects of screening thus higher utilisation and Page | 126
subsequent lower morbidity. A special counselor should be installed at the facility to ensure that thorough and
concrete information is given during the counseling exercise. Partners should be advised to continue being
supportive and aid in any cervical cancer services/treatment process which lowers the possibility of cervical cancer.
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CITE AS: Musubika Judith (2024). Factors Influencing Utilization of

Cervical Cancer Screening Services among Women 20 Years or More
Attending KIU-Teaching Hospital in Ishaka Bushenyi. NEWPORT Page | 128
INTERNATIONAL JOURNAL OF RESEARCH IN MEDICAL
SCIENCES,5(1):118-128.
https://doi.org/10.59298/NIJRMS/2024/118.12757.1400

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(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.